Which treatments are typically covered by MetLife dental plans?

A:

Quick Answer

MetLife dental plans cover more than 400 procedures, including cleanings, examinations, fillings, root canals and comprehensive orthodontic treatment, as of 2015. Most plans also cover part of the cost for services such as implants, white fillings, IV sedation and general anesthesia.

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A MetLife dental plan provides benefits for basic, intermediate, major and extreme procedures, from paying 100 percent for biannual cleanings and exams to paying between 20 and 70 percent of other procedures, depending on plan type and where the member gets the services rendered. For some unlisted services, MetLife also negotiates a 25 percent discount with its in-network providers.

Getting services from an in-network provider increases how much MetLife pays. For example, for intermediate services such as fillings, MetLife pays 55 percent for members with standard plans who receive services from an in-network provider and 40 percent for services from an out-of-network provider. For members with the high-option plan, MetLife pays 70 percent for intermediate services received from an in-network provider and 60 percent for services from an out-of-network provider.

MetLife limits how much it pays for some procedures over a member's lifetime. For example, MetLife pays up to $1,500 for in-network procedures and up to $800 for out-of-network procedures for someone with a standard plan, and up to $20,000 for in- and out-of-network procedures for someone with a high-option plan. While MetLife's standard plan does not cover adult orthodontia, it covers orthodontia for children, paying up to $2,000 for in-network services and up to $1,500 for out-of-network services over the child's lifetime. Its high-option plan covers up to $1,500 in orthodontia services for adults and up to $3,500 for children.